MEDICARE: DR. CHARLES ALLEN DALLARA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD049459L	PA

General Provider Information

NPI Number	:	1487646014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ALLEN DALLARA M.D.

Provider Business Mailing Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	SUITE 2507 HEALTH CENTER 2
City	:	MEDIA
State	:	PA
Zip	:	19063-5146
Country	:	US
Telephone Number	:	610-627-4427
Fax Number	:	610-891-3417

Provider Business Practice Location Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	SUITE 2507 HEALTH CENTER 2
City	:	MEDIA
State	:	PA
Zip	:	19063-5146
Country	:	US
Telephone Number	:	610-627-4427
Fax Number	:	610-891-3417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	10/03/2016

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